The California Department of Public Health (DPH) has created an antimicrobial stewardship program (ASP) collaborative to help hospitals in the state implement or enhance their ASPs. The program aims to ensure that “all California hospitals have a functional and robust ASP to promote patient safety and to decrease antimicrobial resistance.”1
This collaborative falls in step with a state law passed in September 2014 requiring hospitals by July 1, 2015 to implement an antimicrobial stewardship policy that follows federal and professional guidelines, and to establish an antimicrobial stewardship committee with a physician or pharmacist with specific training related to stewardship.1 The California DPH Healthcare-Associated Infection Program received a five-year grant from the Centers for Disease Control and Prevention to promote ASP initiatives. The Collaborative is one of the programs supported by the grant.
The ASP Collaborative will be operational until December 2015 and will provide participating hospitals with:
- An evaluation of their current ASP, including the program’s strengths and weaknesses compared to the elements of the DPH’s three-tier ASP program.
- Bi-monthly webinars led by stewardship experts, who will discuss enlisting leadership support, program development, outcome measurements, reporting, education and interventions.
- Bi-monthly conference calls (alternating with the webinars) for hospitals to discuss challenges and share best practices and tools with other hospitals of similar size or characteristics.
- Templates for documents and tools that hospitals can customize based on their size and services provided.
- Support from the staff of DPH’s healthcare-associated infection program staff.
In addition to the Collaborative, California continues to offer the Spotlight on Antimicrobial Stewardship Programs project, under which hospitals volunteer to share their progress toward implementing a high-performing ASP. Currently, 35 hospitals participate in the program and have provided their status toward implementing all 11 elements of the DPH’s three-tier antimicrobial stewardship program. Each of the hospitals has also shared the contact information for its infectious disease physicians and the pharmacist involved in or leading their ASP. 2
The three-tier program includes the following elements:
- Hospital antimicrobial stewardship policy/procedure
- Physician-supervised multidisciplinary antimicrobial stewardship committee, subcommittee or workgroup
- Program support from stewardship-trained physician or pharmacist
- Reporting of ASP activities to the hospital’s quality improvement committees
- Annual antibiogram developed using Clinical Laboratory Standards Institute guidelines distributed and explained to clinical staff
- Institutional guidelines for the management of common infection syndromes, including tools such as order sets, clinical pathways, recommended empiric therapy
- Monitoring of antimicrobial use patterns determined to be important to the resistance ecology of the facility, using Defined Daily Dosing (DDD) or Days of Therapy (DOT)
- Regular education of hospital staff on antimicrobial stewardship
- Annually reviewed antimicrobial formulary, updated based on local antibiogram
- Prospective audits of antimicrobial prescriptions performed and intervention/feedback provided
- Formulary restriction with preauthorization implemented
1 Epson, E. Invitation to the Antimicrobial Stewardship Program (ASP) Collaborative. November 17, 2014.
2 The California Antimicrobial Stewardship Program Initiative. California Department of Public Health. http://www.cdph.ca.gov/programs/hai/Pages/AntimicrobialStewardshipProgramInitiative.aspx